Cirugía de la fibrilación auricular

Atrial fibrillation surgery is based on creating scars in the atrium, in order to avoid re-entry phenomena that may initiate and perpetuate arrhythmia, and driving the normal stimuli from the sinus node to the atrio-ventricular node. The complexity and increased risk of the initial surgical technique, based on a "cut-and-sew" procedure, have enhanced other current procedures, in which different energies are used making it possible to perform scars in a safer and less invasive way. At present, atrial fibrillation surgery is not performed routinely in all cardiothoracic surgical centers, and there is no consensus in which is the best type of technique. Even if the results are good, they depend on multiples factors such as duration of arrhythmia, atrial size and type of technique employed. In addition, there is some variability in the description within the scientific community of the results and procedures used, which makes its analysis confusing. In this paper we review the different techniques described, the results and their application in minimally invasive surgery

Progresos en cirugía cardiaca

The development of cardiovascular surgery has been accompanied by a series of advances in complementary technology, which has made it possible to carry out safer and less aggressive surgery. In this article there is a review of the latest progress in coronary and valvular surgery, cardiac insufficiency, arrhythmia and the application of extracorporeal circulation in non-cardiac diseases. These advances can serve as the starting point in order to build a future adapted to the needs generated by both patient and diseas

Surgical approach for cardiac surgery in a patient with tracheostoma

The thoracic approach for cardiac surgery in a patient with a tracheostoma can result in difficult problems, such as mediastinitis, stoma necrosis or inadequate operative exposure. We present a distinct approach consisting of an incision at the second intercostal space, transverse sternum transection and longitudinal median sternotomy to the xiphoid process, performed for coronary artery bypass grafting and aortic valve replacement, in a patient with previous tracheotomy. This approach permitted adequate surgical exposure for cardiopulmonary bypass, aortic valve replacement and coronary revascularization procedures

Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass?

It has been suggested that desmopressin acetate (DDAVP) administration reduces blood loss after cardiac surgery. We have investigated the effect of DDAVP administration in a double-blind, randomized, prospective trial including 100 patients placed on cardiopulmonary bypass during surgery. Fifty patients received 0.3 micrograms/kg DDAVP and 50 patients received a placebo administered in a 50 ml saline solution over 15 min when cardiopulmonary bypass had been concluded. Results showed no significant differences either in total blood loss per square meter (458 +/- 206 ml in the DDAVP group vs 536 +/- 304 ml in the placebo group) or in necessity for red cell transfusions (1642 +/- 705 ml in the DDAVP group vs 1574 +/- 645 ml in the placebo group) in the first 72 hr after surgery. Only intraoperative blood loss per square meter was significantly lower (p less than .02) in the DDAVP group (131 +/- 106 ml) as compared with the placebo group (193 +/- 137 ml). The prolongation of bleeding time and the decrease of factor VIII:C and factor VIII:von Willebrand factor 90 min after treatment were significantly lower (p less than .001) in the DDAVP group as compared with the placebo group. We conclude that the administration of DDAVP in patients placed on cardiopulmonary bypass during surgery does not reduce total blood loss and is only effective in reducing intraoperative bleeding

Reoperación coronaria por toracotomía izquierda sin circulación extracorpórea después de laringuectomía: seguimiento a nueve años

The use of left thoracotomy is an alternative approach in redo coronary surgery in selected patients for whom median sternotomy is potentially hazardous. We present a patient in whom a redo reoperative coronary revascularization was performed off-pump via left thoracotomy to avoid a tracheal stoma. Nine years after reoperation the patient remains free of cardiac symptoms. In selected patients, redo coronary bypass grafting can be performed without cardiopulmonary bypass through a left thoracotomy, with a low perioperative morbidity and mortality rate and good long-term symptomatic improvement.La toracotomía izquierda es una vía de acceso alternativa en las reoperaciones coronarias en algunos enfermos en los cuales la reesternotomía puede ser peligrosa. Presentamos un enfermo en quien realizamos una reoperación coronaria sin circulación extracorpórea a través de una toracotomía izquierda para evitar una incisión quirúrgica en las proximidades de una traqueotomía permanente. Nueve años después el enfermo permanece asintomático. En casos seleccionados se pueden realizar reoperaciones coronarias sin circulación extracorpórea a través de una toracotomía izquierda con morbilidad y mortalidad bajas y con buenos resultados a largo plazo

Falso aneurisma aórtico 30 años después de la corrección de una coartación: tratamiento quirúrgico bajo hipotermia profunda

We report a case of a large false aortic aneurysm that had developed in a 43-year-old man who had had coarctation repair 30 years previously. The coarctation repair had been done by inserting an end-to-end Dacron tubular graft which was sutured with silk. The re-operation was successfully performed under deep hypothermic arrest and it was noted that there was complete separation of the graft from both ends and no sutures were visualised. The deep hypothermic technique has considerably improved the ease and safety of this operation. We attribute this complication to the reabsorption of the silk sutures. Patients after coarctectomy with graft material should have regular chest X-rays for life in order to detect false aneurys

Comunicación entre la arteria coronaria derecha y la aurícula derecha

Two cases of anomalous communication of the right coronary artery with the right atrium (the so-called coronary artery fistula) are presented. Both were young females in which a continuous murmur was heard during routine examination. The x-ray image was typical, with a huge bulge in the right border similar to that seen in cases of right atrium enlargement. The ECG was normal in both patients. The diagnosis was made during cardiac catheterization and angiocardiography. A slight left-to-right shunt was present and the aneurismatic dilatation of right coronary artery and communication with the right atrium could be documented. In both cases a surgical closure of the defect was performed, both being well after two years and eight months respectively

Aneurisma de aorta ascendente en pacientes con sustitución valvular aórtica previa

We conclude that an aggressive surgical approach should be adopted in patients with degenerative aortic regurgitation and moderate dilatation of the ascending aorta because of the rapid progression of the aortic disease. We advise complete replacement of the aortic root